Management of new symptoms of dyspepsia in the elderly in Quebec.
OBJECTIVE
To use the Régie de l'assurance-maladie du Québec (RAMQ) database to study the clinical strategies used by Quebec physicians in the management of dyspepsia in the elderly.


METHODS
A 20% random sample of the RAMQ database for Quebec residents aged 65 years and older for the three years from July 1, 1991 to June 30, 1992 was used. Patients were placed in three cohorts according to the following treatment strategies: endoscopy, x-ray examination or drug therapy. Patients in each cohort were then categorized as either nonsteroidal anti-inflammatory drug (NSAID) users or non-NSAID users. The choice of drug treatment used to manage the dyspepsia in each cohort was recorded. Drug treatments were divided into the following six antidyspeptic categories: H2 blockers, omeprazole, sucralphate, misoprostol, prokinetic drugs or no drugs. The number of duodenal, oesophageal and stomach cancers diagnosed in each cohort was also counted.


RESULTS
Drug therapy was the most frequently used strategy in all patients, and was used more frequently in NSAID users (87%) than in non-NSAID users (69%). A total of 22% of NSAID users in each group, and 46% of NSAID users in the drug therapy group, underwent investigation. H2 blockers were the most prescribed drug in all three treatment strategies, and omeprazole was the second most prescribed drug in the endoscopy and x-ray cohorts. Overall omeprazole was the least prescribed drug. There was a higher rate of cancer detection in the endoscopy and x-ray cohorts than in the drug therapy group.


CONCLUSIONS
Previous NSAID use greatly influences the way in which physicians treat patients with dyspepsia.
LeLorier
J
J
Centre de Recherche, Hôtel-Dieu de Montréal, Quebec. leloriej@ere.umontreal.ca
Pagé
V
V
Castilloux
A M
AM
LeLorier
Y
Y
D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D000897:Anti-Ulcer Agents / Q000191:economics / Q000627:therapeutic use; D015331:Cohort Studies; D019992:Databases as Topic; D016527:Drug Costs; D011307:Drug Prescriptions; D004379:Duodenal Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging; D004415:Dyspepsia / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000628:therapy*; D016099:Endoscopy, Gastrointestinal; D004938:Esophageal Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use; D005769:Gastrointestinal Motility / Q000187:drug effects; D006635:Histamine H2 Antagonists / Q000627:therapeutic use; D006801:Humans; D008297:Male; D016595:Misoprostol / Q000627:therapeutic use; D009853:Omeprazole / Q000191:economics / Q000627:therapeutic use; D010818:Practice Patterns, Physicians'; D011792:Quebec; D011859:Radiography; D013274:Stomach Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging; D013392:Sucralfate / Q000627:therapeutic use
D000894:Anti-Inflammatory Agents, Non-Steroidal; D000897:Anti-Ulcer Agents; D005765:Gastrointestinal Agents; D006635:Histamine H2 Antagonists; D016595:Misoprostol; D013392:Sucralfate; D009853:Omeprazole